摘要
目的:探讨动态血糖监测(CGM)联合胰岛素泵治疗妊娠期糖尿病(GDM)疗效及对患者糖脂代谢的控制效果。方法:选取2019年10月-2020年6月本院收治的GDM患者226例,随机分为对照组与观察组各113例,两组均接受CGM,对照组采用每日胰岛素多次注射,观察组采用胰岛素泵治疗。比较两组血糖控制效果,治疗前后空腹血糖(FBG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、平均血糖波动幅度(MAGE)、低血糖时间百分比、高血糖时间百分比、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C),测定血清脂联素(APN)、脂肪酸结合蛋白4(FABP4)与趋化素(Chemerin)指标,随访妊娠结局和围产儿结局。结果:治疗后,观察组胰岛素用量(31.02±5.01 U/d)、血糖达标时间(3.31±0.59 d)均小于对照组(36.74±8.12U/d、3.94±0.73 d),孕34周时HbA1c达标率(69.9%)高于对照组(54.9%),FPG、2h PG、HbAlc、HOMA-IR、MAGE、高血糖及低血糖时间占比、TG、TC、LDL-C、血清FABP4及Chemerin均低于对照组,而APN高于对照组(均P<0.05);观察组妊娠期高血压疾病、早产、产后感染、围产儿窒息及新生儿低血糖发生率等均低于对照组(均P<0.05)。结论:CGM联合胰岛素泵治疗GDM可通过调节糖脂代谢指标及脂肪细胞因子等,提高血糖控制效果,改善妊娠结局。
Objective:To explore the efficacy of dynamic monitoring glucose combined with insulin pump infusion for treating pregnant women with gestational diabetes mellitus(GDM),and to study its influence on the control effect of glucose and lipid metabolism of the women.Methods:A total of 226 pregnant women with GDM who had received dynamic monitoring glucose were selected and randomly divided into control group and observation group(113 cases in each group)from October 2019 to June 2020.The women in the control group were given insulin by multiple daily injections(MDI),and the women in the observation group were given insulin pump infusion.The blood glucose control effect of the women was compared between the two groups.The levels of fasting blood glucose(FBG),2 h postprandial blood glucose(2 hPG),and glycosylated hemoglobin(HbA1 c),the values of insulin resistance index(HOMA-IR)and mean amplitude of glycemic excursions(MAGE),the percentages of time for hypoglycemia and time for hyperglycemia,and the levels of total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)of the women were compared between the two groups.The indexes of serum adiponectin(APN),fatty acid binding protein 4(FABP4),and chemotactic(Chemerin)of the women in the two groups were detected.The pregnancy outcomes and the perinatal outcomes of the women in the two groups were followed up.Results:After treatment,insulin dosage(31.02±5.01 U/d)and the time of blood glucose level returned to normal(3.31±0.59 d)of the women in the observation group were significantly lower than those(36.74±8.12 U/dand 3.94±0.73 d)of the women in the control group.The rate of reaching the standard of HbA1 c(69.9%)of the women in the observation group during 34 gestational weeks was significantly higher than that(54.9%)of the women in the control group.The levels of FPG,2 HPG,HbAlc,MAGE,the HOMA-IR value,the ratio of hyperglycemia,and the levels of serum hypoglycemia,TG,TC,LDL-C,FABP4,and Chemerin of the women in the observation group were significantly lower than those of the women in the control group,while the APN level of the women in the observation group was significantly higher(all P<0.05).The incidences of hypertension,premature delivery,postpartum infection,perinatal asphyxia,and neonatal hypoglycemia of the women in the observation group were significantly lower than those of the women in the control group(P<0.05).Conclusion:Dynamic monitoring glucose combined with insulin pump for treating the pregnant women with GDM can improve their effect of blood sugar control and pregnancy outcomes by regulating glucose and lipid metabolism indexes and adipocytokines.
作者
张茜
卞文伟
梁少琴
ZHANG Xi;BIAN Wenwei;LIANG Shaoqin(Nanjing Tongren Hospital Affiliatedto School of Medicine,Southeast University,Jiangsu Province,211102)
出处
《中国计划生育学杂志》
2022年第3期556-561,共6页
Chinese Journal of Family Planning
关键词
妊娠期糖尿病
动态血糖监测
胰岛素泵
糖脂代谢
脂肪细胞因子
妊娠结局
Ggestational diabetes mellitus
Dynamic monitoring glucose
Insulin pump
Glucose and lipid metabolism
Adipocytokines
Pregnancy outcomes
